Published online Jul 16, 2024. doi: 10.12998/wjcc.v12.i20.4348
Revised: May 18, 2024
Accepted: June 4, 2024
Published online: July 16, 2024
Processing time: 114 Days and 18.4 Hours
Pituitary stalk interruption syndrome (PSIS) is a rare anatomical defect of the pituitary gland falling under the spectrum of holoprosencephaly phenotypes. It is characterized by a deficiency in anterior pituitary hormones, such as growth hormone, gonadotropins, and thyroid hormones. Due to the syndrome's rarity and nonspecific manifestations, there is a lack of standardized treatment strategies. Consequently, early diagnosis through imaging and on-time intervention are crucial for improving patients’ outcomes.
A 30-year-old man presented with absent secondary sexual characteristics and azoospermia. Laboratory evaluation revealed a deficiency in gonadotropins, while thyroid function was mostly within normal ranges. Magnetic resonance imaging of the pituitary gland showed pituitary stalk agenesis, hypoplasia of the anterior pituitary, and ectopic posterior pituitary, leading to the diagnosis of PSIS. Initially, the patient underwent 6 mo of gonadotropin therapy without significant changes in hormone levels and secondary sexual characteristics. Pulsatile gonadotropin-releasing hormone therapy was then administered, resulting in the detection of sperm in the semen analysis within 3 mo. After 6 mo, routine semen tests showed normal semen quality. The couple faced challenges in conceiving due to abstinence and underwent three cycles of artificial insemination, which was unsuccessful. They also attempted in vitro fertilization, but unfortunately, the woman experienced a miscarriage 10 wk after the embryo transfer.
Early detection, accurate diagnosis, and timely treatment are crucial in improving the quality of life and fertility of PSIS patients.
Core Tip: Pituitary stalk interruption syndrome (PSIS) is a rare anatomical defect affecting the pituitary gland, falling within the spectrum of holoprosencephaly phenotypes. In cases where fertility is a concern, treatment options typically involve pulsatile gonadotropin-releasing hormone (GnRH) therapy and gonadotropin therapy. This case study highlights a patient with PSIS who initially did not respond to gonadotropin therapy but showed successful spermatogenesis upon switching to pulsatile GnRH therapy. Timely identification, accurate diagnosis, and tailored treatment play a vital role in enhancing the quality of life and fertility outcomes for individuals with PSIS.